Latest / Becker’s Healthcare Podcast / Building the AI Infrastructure for Medication Access with Sahir Jaggi

Transcript

Building the AI Infrastructure for Medication Access with Sahir Jaggi · Becker’s Healthcare Podcast

• 0:02
  - Every health system executive right now is being
• 0:04
  - asked to do something that has no useful
• 0:06
  - precedent,
• 0:07
  - make durable technology decisions in an environment that
• 0:10
  - looks meaningfully different every six months.
• 0:13
  - The pace isn't slowing,
• 0:14
  - the vendor landscape isn't getting simpler, and the
• 0:17
  - cost of missteps
• 0:18
  - keeps rising.
• 0:19
  - Becker's eleventh annual IT and Revenue Cycle Conference,
• 0:23
  - The Future of AI and Digital Health, exists
• 0:25
  - for exactly this challenge.
• 0:27
  - Here, you'll find more than 2,500 executive level
• 0:30
  - attendees,
• 0:31
  - 600 plus speakers, and four days of sessions
• 0:34
  - built around the questions leaders are actually wrestling
• 0:36
  - with.
• 0:37
  - How to scale AI responsibly,
• 0:39
  - how to protect increasingly complex systems,
• 0:42
  - how to wring more performance out of the
• 0:44
  - revenue cycle, and how to make tech investments
• 0:46
  - that hold up over time.
• 0:48
  - Join us September fourteenth through the seventeenth at
• 0:51
  - the Hilton Chicago.
• 0:53
  - You can register on our events page at
• 0:55
  - beckershospitalreview.com
• 0:57
  - by clicking on the events tab in the
• 0:59
  - upper right.
• 1:00
  - This is Scott Becker with the Becker's Health
• 1:03
  - Care podcast.
• 1:04
  - I'm thrilled to be joined by a brilliant
• 1:07
  - and incredible entrepreneur.
• 1:09
  - We're joined today by Sahir
• 1:11
  - Jaggi. Sahir
• 1:12
  - is the founder of a company called Flores,
• 1:15
  - recently went through a rebrand. And he'll tell
• 1:17
  - us about Flores and and what you're doing
• 1:20
  - and how you've grown so much. I've been
• 1:22
  - introduced by Sahir by somebody who's brilliant, had
• 1:25
  - a chance to visit with him, and and
• 1:27
  - one of the smartest
• 1:29
  - young entrepreneurs that I know, although maybe not
• 1:31
  - that young, but look so young. Sahir, tell
• 1:33
  - us a bit about the founding of Phorus
• 1:35
  - and and what you're doing, and tell us
• 1:37
  - a bit about you and your background too.
• 1:40
  - Yeah. Thanks so much for having me, Scott.
• 1:42
  - I really appreciate it, and and and really
• 1:43
  - excited to be here. So like you mentioned,
• 1:46
  - I started a company a few years ago
• 1:48
  - called Phorus.
• 1:49
  - Forus is a platform for automating access to
• 1:51
  - medication.
• 1:52
  - You know, we're building the layer that accelerates
• 1:54
  - medicine for people who need it, who prescribe
• 1:56
  - it, who create it. We started this company
• 1:58
  - about three years ago and have spent that
• 2:00
  - whole time kinda supporting providers and patients across
• 2:03
  - the country,
• 2:04
  - helping people get access to medicine faster, easier,
• 2:06
  - and cheaper by automating all the complexity that
• 2:09
  - normally falls in their shoulders. Right? If you
• 2:11
  - think about the problem that we've set out
• 2:12
  - to solve, when a doctor prescribes a medication
• 2:15
  - today, there's often a long manual process before
• 2:18
  - the patient can actually get it. The prioritization,
• 2:20
  - the documentation the plan wants, the appeal when
• 2:23
  - it's denied, and figuring out how the patient
• 2:24
  - affords it. And the AMA found that,
• 2:28
  - most recently, physicians and their staff are spending,
• 2:30
  - you know, thirteen, fourteen hours a week on
• 2:32
  - prior authorizations,
• 2:34
  - seeing, you know, nearly 40 of those authorizations
• 2:36
  - per provider per week,
• 2:39
  - in their clinics, and nearly four in five
• 2:41
  - providers say patients end up abandoning treatment because
• 2:44
  - of that process.
• 2:45
  - And it falls hardest on people with the
• 2:47
  - most serious expensive conditions. So think autoimmune diseases,
• 2:50
  - metabolic disorders, cancers, where the drugs are expensive
• 2:53
  - and and unaffordable without insurance coverage or financial
• 2:56
  - assistance and complicated supply chains.
• 2:58
  - And so our platform
• 3:00
  - is the automation layer for all of that.
• 3:02
  - Our AI facilitates every step in the process
• 3:05
  - from identifying what insurance coverage and benefits a
• 3:07
  - patient has,
• 3:08
  - through generating the prior authorizations and appeals, coordinating
• 3:11
  - the back and forth with health plans and
• 3:13
  - PBMs and pharmacies,
• 3:14
  - and even working through the different affordability and
• 3:16
  - financial assistance options for patients.
• 3:19
  - That work
• 3:20
  - used to keep someone in the office on
• 3:21
  - the phone all day and now can be
• 3:23
  - handled automatically.
• 3:25
  - So this is really what we we built,
• 3:26
  - and and what's what's best here is that
• 3:28
  - we've been able to build it in a
• 3:29
  - way that's free for providers and patients. I
• 3:31
  - think what you're seeing in the market today
• 3:33
  - is a lot of the best tools providers
• 3:34
  - rely on tend to be free for them,
• 3:36
  - and I don't think that's a coincidence. And
• 3:37
  - providers are stretched way too thin to be
• 3:40
  - paying for the infrastructure
• 3:41
  - that they depend on and the cost these
• 3:43
  - broad leased platforms,
• 3:44
  - I think, increasingly belongs with larger players in
• 3:46
  - the system that have a margin to carry
• 3:48
  - it. Think, you know, payers, life science companies,
• 3:50
  - even the government, rather than the people at
• 3:52
  - the front line. And so,
• 3:54
  - we've been working on this for a few
• 3:55
  - years now, and as you mentioned, just did
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  - a big public launch as a result of
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  - our funding.
• 3:59
  - Well, congratulations.
• 4:01
  - And talk about your background because brilliant person
• 4:04
  - in Columbia University
• 4:06
  - spent years developing strategy at Oscar Health.
• 4:10
  - How did you end up
• 4:11
  - transitioning to this area and deciding to lead
• 4:14
  - and found this?
• 4:16
  - Yeah. So as you mentioned, I joined Oscar
• 4:19
  - Health back in 2017,
• 4:21
  - right, when the company is trying to scale
• 4:22
  - up really significantly,
• 4:24
  - and that gave me a front row seat
• 4:25
  - to the full,
• 4:27
  - spectrum of problems in the health care system.
• 4:29
  - Right? Working at Oscar, I was working most
• 4:31
  - prominently on our actual patient and consumer experience
• 4:35
  - and spending a lot of time thinking about
• 4:36
  - what are the different ways in which we
• 4:37
  - can make people's lives easier in such a
• 4:40
  - complicated system.
• 4:42
  - I got a ton of exposure there to
• 4:43
  - problems across everything from how challenging it is
• 4:46
  - to pick and buy your insurance plan, through
• 4:48
  - how hard it is to understand what your
• 4:50
  - benefits are, through figuring out, you know, what
• 4:52
  - happens when someone prescribes you a medication or
• 4:55
  - orders you a test,
• 4:56
  - how do you know where you can go,
• 4:58
  - what's in network,
• 4:59
  - and and even kind of figuring out, you
• 5:01
  - know, what people need to do when they
• 5:05
  - have an emergency. You know, there's there's a
• 5:06
  - wide variety of problems. And I think what
• 5:08
  - I learned at Oscar
• 5:09
  - was being a single player in the ecosystem,
• 5:13
  - you can solve
• 5:14
  - some of the problems for some of the
• 5:15
  - people some of the time, but it's really
• 5:17
  - challenging to provide a solution
• 5:19
  - that is universal
• 5:21
  - or or or durable for any for any
• 5:23
  - individual,
• 5:24
  - provider or patient. Just because, you know, throughout
• 5:26
  - their life, they're gonna go through a variety
• 5:28
  - of different insurance plans, a variety of different
• 5:30
  - providers, a variety of different treatments.
• 5:33
  - And
• 5:34
  - what happened while I was there was we
• 5:36
  - started to see this advent of new technology
• 5:39
  - and and AI and large language models, which
• 5:41
  - obviously, you know, you and many of listeners
• 5:42
  - I'm sure are quite familiar with. And luckily
• 5:45
  - for me, a number of the main investors
• 5:47
  - at Oscar were also deeply involved
• 5:50
  - in the companies behind this technology,
• 5:52
  - and that started getting my brain clicking,
• 5:55
  - as to air is there an opportunity to
• 5:56
  - build something that can work for everyone all
• 5:59
  - the time as opposed to only working for
• 6:01
  - a slice of folks some of the time.
• 6:03
  - And that technology, I think, opened the door
• 6:05
  - where these AI models are really good at
• 6:08
  - a couple of things that I think provide
• 6:09
  - the capability
• 6:10
  - to do more. One is they can digest
• 6:13
  - a tremendous amount of different, you know, heterogeneous
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  - information
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  - and treat it all the same. And two,
• 6:18
  - they can kind of brute force through really
• 6:21
  - hard processes that are hard to scale with
• 6:22
  - people. And so that kind of gives you
• 6:24
  - an opportunity to build what I think of
• 6:25
  - as an abstraction or advocate layer,
• 6:27
  - on top of the system, helping people navigate
• 6:30
  - it without having to understand all the complexity
• 6:31
  - underneath. And so,
• 6:33
  - after spending five, six years at Oscar really
• 6:35
  - learning the ropes of both the health care
• 6:37
  - system, but also how to build a fast
• 6:39
  - growing company, I made the leap to start
• 6:41
  - this company, working with a lot of the
• 6:42
  - same investors, a lot of the same team
• 6:44
  - focused on this problem.
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  - Really remarkable. So you've been at it for
• 6:48
  - about three years now. And give us a
• 6:50
  - bit of a sense of how it's going.
• 6:53
  - Who do you who does your who do
• 6:55
  - you reach out to? Who's your ideal
• 6:57
  - customer?
• 6:58
  - Who do you folks work with?
• 7:00
  - And and how do you sort of get
• 7:02
  - into the market and distribution?
• 7:05
  - Yeah. So, I mean, what I'm really excited
• 7:08
  - about is that we have been able to
• 7:09
  - grow with the providers and the patients for
• 7:12
  - the last few years almost entirely through word-of-mouth.
• 7:15
  - For the last couple years, we have 10
• 7:17
  - x year over year for for two years
• 7:19
  - running, and now we're used
• 7:21
  - by thousands of medical practices and health systems
• 7:23
  - across all 50 states,
• 7:26
  - from SAW solo private practices all the way
• 7:28
  - up through academic health systems.
• 7:31
  - And we serve patients now in about 80%
• 7:33
  - of residential ZIP codes in The US.
• 7:35
  - And and really what that's looked like is,
• 7:37
  - you know, we're providing this product, which I
• 7:39
  - think is solving a really
• 7:41
  - key issue
• 7:42
  - for physicians and patients, helping them get their
• 7:45
  - medicine, a problem that's not only complicated, but
• 7:47
  - also a recurring problem for all these folks
• 7:49
  - on a regular basis. If, you know, if
• 7:50
  - you're prescribed a medication, you're usually taking that
• 7:52
  - medication every day, every week, every month for
• 7:55
  - the rest of your life, with your chronic
• 7:56
  - condition. And and at the same time, a
• 7:58
  - lot of providers and specialists, and a huge
• 8:00
  - portion
• 8:01
  - of what they do today is focused on
• 8:04
  - medications and prescriptions and infusions and making sure
• 8:06
  - people can get the treatments that are gonna
• 8:08
  - be most effective for their conditions.
• 8:10
  - And so we started very early on kind
• 8:12
  - of working with physicians and and providers who
• 8:15
  - were family friends or friends of friends or
• 8:17
  - people we knew kind of through our network,
• 8:19
  - and that kind of helped us get the
• 8:21
  - ball rolling. And then very quickly, we started
• 8:23
  - to see the kind of the word started
• 8:25
  - spreading and through dinners, through friends, through people
• 8:28
  - switching jobs, through Facebook groups, the world started
• 8:30
  - to grow and we started to kinda see
• 8:32
  - a exponential growth in our kind of,
• 8:36
  - inbound from physician groups and and health systems,
• 8:39
  - interested in finding ways to solve these problems
• 8:41
  - where they and their staff just don't have
• 8:43
  - the capacity
• 8:44
  - to to address it themselves, and they're they're
• 8:46
  - hungry for AI solutions that can solve the
• 8:49
  - problem.
• 8:50
  - And and take a moment on
• 8:52
  - as we move to the second part of
• 8:54
  - two thousand twenty six, what are you most
• 8:56
  - focused on and excited about the rest of
• 8:58
  - this year?
• 9:00
  - Yeah. Well, so what I'm most excited about
• 9:02
  - is how much more AI can take on
• 9:05
  - now than it could even a year ago.
• 9:07
  - We're moving past the level of AI that
• 9:09
  - just helps you do a task faster to
• 9:11
  - AI that really owns the entire workflow end
• 9:13
  - to end. I think the difference between a
• 9:16
  - team feeling a little bit less buried and
• 9:18
  - a team not having to think about a
• 9:19
  - problem at all because it's really kind of,
• 9:21
  - you know, offloaded from their shoulders is so
• 9:23
  - tremendous in terms of the impact it can
• 9:25
  - have, not just for them directly, but for
• 9:27
  - the patients they serve because they can put
• 9:29
  - their
• 9:30
  - full,
• 9:31
  - mind towards the problems that they really needed.
• 9:34
  - And because the models keep getting better, the
• 9:36
  - set of things that you can, you know,
• 9:38
  - continually automate basically gets bigger and better almost
• 9:41
  - every month these days.
• 9:43
  - That part has really kinda kept me up
• 9:44
  - in a good way. What we're focused on
• 9:46
  - now is turning that depth,
• 9:49
  - into,
• 9:51
  - you know, more and more impactful settings we
• 9:53
  - serve most.
• 9:54
  - For example, at the health system level, we're
• 9:56
  - we're moving beyond kind of the core problems
• 9:58
  - of helping automate all the authorization and and
• 10:01
  - and access process and routing within the system
• 10:04
  - to things that are more bespoke and specific
• 10:06
  - that require additional levels of complexity. So think,
• 10:08
  - you know, carrying a patient's therapy
• 10:11
  - across the inpatient to outpatient transition so someone
• 10:14
  - discharging a new medication doesn't fall through on
• 10:16
  - access or cost.
• 10:18
  - For example, in in in specialties like oncology,
• 10:21
  - it's ensuring that you're getting all the paperwork,
• 10:23
  - the authorization, the financial assistance handled at the
• 10:26
  - right time before treatment, navigating the scheduling so
• 10:29
  - that, you know, a patient isn't in the
• 10:31
  - chair waiting on paperwork. And you're really kind
• 10:33
  - of thinking about the through line
• 10:35
  - of how can you take a platform that
• 10:37
  - has a ton of automation capability with AI
• 10:39
  - already and molding it to each individual setting,
• 10:42
  - continually making it more impactful for each type
• 10:44
  - of,
• 10:45
  - provider or partner you serve. I think that's
• 10:48
  - a really exciting thing that is possible because
• 10:51
  - of how much more capable these agentic systems
• 10:53
  - are today.
• 10:55
  - I mean, really fascinating. You've done this incredible
• 10:57
  - job
• 10:58
  - from being at Oscar Health to founding this
• 11:01
  - company and really understanding sort of the the
• 11:03
  - levels of scale.
• 11:06
  - Any advice that you would give to emerging
• 11:09
  - founders, emerging entrepreneurs that you've learned from your
• 11:12
  - lesson so far?
• 11:14
  - Yeah. I mean, I think now is probably
• 11:16
  - the most exciting time to be building a
• 11:18
  - company and be supporting people who are looking
• 11:21
  - for ways to have AI transform
• 11:23
  - their organizations, their work, their lives. And so
• 11:26
  - my my advice is really around, I think,
• 11:28
  - two things.
• 11:29
  - One is to be really ambitious
• 11:32
  - about what you're asking from your your product.
• 11:34
  - I think, you know, there's often a
• 11:37
  - instinct to kind of be conservative in your
• 11:40
  - approach and start small and pick something off
• 11:42
  - that you can kind of solve for folks
• 11:44
  - and kind of grow from there. And I
• 11:45
  - think that's right. But also you wanna kinda
• 11:47
  - make sure that the long term of what
• 11:48
  - you're you're you're working towards and what you're
• 11:50
  - able to share with your partners
• 11:52
  - is something that can, you know, take entire
• 11:55
  - categories
• 11:56
  - of work and manual process
• 11:58
  - off of your customer's plate, not just help
• 12:00
  - them do something faster. Right? Really aiming higher
• 12:02
  - than just efficiency
• 12:04
  - to, you know, transforming
• 12:06
  - how people are operating. So that's what's gonna
• 12:08
  - be most,
• 12:09
  - impactful and and also most durable as kind
• 12:11
  - of, you know, technology continues to advance. And
• 12:14
  - then choose partners
• 12:16
  - who want you to work with them to
• 12:17
  - adapt their settings and help you develop your
• 12:19
  - product. Right? Your your the product you build
• 12:22
  - is
• 12:23
  - kinda culmination of both your internal efforts, but
• 12:26
  - also
• 12:27
  - how your early partners and customers help you
• 12:30
  - define what you're building.
• 12:31
  - And I think a lot of the best
• 12:33
  - technology today is molding to the specific workflows
• 12:37
  - of customers as opposed to just forcing a
• 12:39
  - template into every setting.
• 12:42
  - And the more,
• 12:43
  - partnership you have from your early clients and
• 12:46
  - customers to help you learn those lessons and
• 12:48
  - build that flexibility into your product, the more
• 12:51
  - quick you'll be able to grow beyond that.
• 12:54
  - And talk about I love what you said
• 12:55
  - about thinking big and ambitiously
• 12:59
  - because so many of us get stuck in
• 13:01
  - incrementalist
• 13:02
  - sort of approaches.
• 13:04
  - And the challenge with that is
• 13:06
  - that so many people can compete with the
• 13:09
  - incrementalist approach, and it's hard to build something
• 13:11
  - significant
• 13:12
  - that people really need if you think small.
• 13:15
  - But many of us are stuck in that
• 13:17
  - in that rut or that that view of
• 13:19
  - the world. Talk about sort of training yourself
• 13:21
  - to think big. Is that part of your
• 13:23
  - Oscar Health background? Is it come comes naturally
• 13:26
  - to you? How'd you come across
• 13:28
  - that kind of thinking
• 13:30
  - versus where many of us get bogged down
• 13:33
  - in sort of such incremental thinking?
• 13:36
  - Yeah.
• 13:37
  - I think, you know, I have to give
• 13:39
  - credit to a couple places for sure. Oscar
• 13:41
  - is a great place to give credit to
• 13:43
  - because, you know, the the original idea was
• 13:45
  - so broad. It was, you know, rather than
• 13:46
  - let's just build a specific,
• 13:50
  - workflow
• 13:51
  - or a specific tool, why don't we rethink
• 13:54
  - what an insurance company looks like and build
• 13:57
  - it from the ground up? You know, there's
• 13:58
  - a lot of complexity in that,
• 14:01
  - but it was a great
• 14:02
  - education for me in how big you can
• 14:05
  - think and how little you need to be
• 14:07
  - tied to
• 14:08
  - what seem like, you know, hard rules. Because
• 14:11
  - in reality, when you think about stuff from
• 14:12
  - first principles, there's a lot more ways to
• 14:14
  - solve every problem than are obvious.
• 14:17
  - I think at the same time, it was
• 14:19
  - a great lesson for, you know, where you
• 14:21
  - do need to be appreciative and and respectful
• 14:24
  - of, like, the systems that exist today and
• 14:26
  - how different organizations operate. And so the thing
• 14:29
  - that's helped me kind of now become a
• 14:31
  - little bit more practical while being ambitious
• 14:34
  - is grounding it in the problems of specific,
• 14:39
  - partners. So thinking about, you know, we want
• 14:41
  - to advance the practice of medicine and make
• 14:44
  - it so that, you know, every patient gets
• 14:47
  - the medicine that is best and most appropriate
• 14:49
  - for them, and science is the only limit
• 14:51
  - to the treatment that they're getting.
• 14:53
  - That's our broad ambitious goal.
• 14:55
  - Now in order to actualize that, we then
• 14:58
  - rather than focusing on it in a, you
• 15:00
  - know, aggregate nonspecific way, think about specific partners,
• 15:04
  - specific practices, specific systems that we we we
• 15:07
  - work with
• 15:08
  - and
• 15:10
  - work to at the same time as kind
• 15:12
  - of being big picture, understanding all the nitty
• 15:14
  - gritty of how they operate to think through,
• 15:16
  - okay, what's
• 15:17
  - a plausible road map for us to get
• 15:19
  - from where we are to that big picture,
• 15:21
  - still working with them and our internal team
• 15:24
  - to have that shared vision of the long
• 15:26
  - term, but then having a pragmatic view along
• 15:29
  - the way. And I think, a lot of
• 15:31
  - that also comes from us having a bit
• 15:33
  - more of a,
• 15:36
  - ethos and thesis around what we think the
• 15:38
  - world should look like. I think one of
• 15:40
  - the great things that I've benefited from
• 15:42
  - in spending my time at Oscar and working
• 15:45
  - within
• 15:45
  - the different complexities of the the system
• 15:48
  - was
• 15:49
  - sort of becoming radicalized
• 15:51
  - on how much challenge there is for patients
• 15:53
  - and providers today
• 15:55
  - and feeling like it would be a disservice
• 15:59
  - to ourselves, our customers, the industry for us
• 16:01
  - to shoot for anything less than what we
• 16:03
  - thought was right for patients.
• 16:05
  - Yeah. I I I think it's a great
• 16:07
  - sort of mix of perspectives of thinking very
• 16:09
  - big, but then also getting you to the
• 16:11
  - weeds and thinking practically
• 16:13
  - about how you make a difference in very
• 16:15
  - specific areas
• 16:17
  - where you're with people you work with need
• 16:19
  - that. I think it's it's it's really a
• 16:20
  - a sense of brilliance.
• 16:22
  - Sahir, I I wanna thank you for joining
• 16:24
  - us today on the Becker's Healthcare podcast.
• 16:27
  - Look forward to speaking to you a lot
• 16:28
  - more and watching the growth in what you're
• 16:30
  - doing it for us. Absolutely brilliant entrepreneur.
• 16:34
  - Thank you so much for joining us. Brilliant
• 16:36
  - person and entrepreneur. Thank you so much for
• 16:38
  - joining us today on the Becker's Healthcare podcast.
• 16:40
  - We really appreciate it. Thank you.
• 16:42
  - Thanks, Scott. Really appreciate you having me on
• 16:44
  - and excited to spend more time together.